Repeat Prescribing – re-design through co-design

Repeat prescriptions account for 80% of prescriptions. The system is inherent with failure demand. We want to develop toolkits to support practices improve their own systems through self-analysis and co-design.

Meet the team: 1000Lives Improvement

In 2015/16, over 79 million prescriptions were issued from GP practices in Wales at a cost of £593 million, showing an increase of 39% over the last 10 years. It is estimated that around 80%of these are repeat prescriptions (http://gov.wales/statistics-and-research/prescriptions-general-medical-practitioners/?lang=en).

Initial improvement work done by 1000 Lives Improvement, shows there is a huge amount of negative variation in the repeat prescribing processes used by GP practices and they are inherent with failure demand and the generation of unnecessary queries.

They vary in terms of staff involved, the number of hand offs, and the information systems used and missed opportunities to improve prescribing.

Community and practice pharmacists across Wales, stated at the 7th Community of Practice hosted by 1000 Lives Improvement, that they have different degrees of involvement but can see areas to improve. The amount of clinical review incorporated into the process differs and the way the system links with chronic disease management is sparse.

GPs currently spend a lot of time signing prescriptions which is generally regarded as ‘wasted time’. One practices calculated that a GP spends 3 weeks of their working year signing scripts.

GPs and other clinical staff also spend a lot of time managing the ‘failure demand’ generated by the process. This contributes to wasted time, possible harm and financial loss through prescribing budgets.

There are many examples of good practice but it is also clear there is no ‘one size fits all’ solution. Our approach it not to simply offer examples of good practice but instead to offer practices a methodology by which they can, with a little support, help themselves to design the processes with scientific rigour to tailor the service to the practice.

1000 Lives already has experience in using tailored mapping techniques and data analysis to help people gain insight into their work and how to improve it within their practice. This builds improvement capability to then use on other future projects.

The next phase would be to develop a break through collaborative for Wales, so that pharmacists can take the methods back to their practice, map it, analyse it and understand it with hands on support upon request.

The funding will help us with;

Sessional time from clinicians willing to work with us to test the idea

Producing high quality materials support the collaboration

Producing communications material to support to engage clinicians an engage the public

Deliver workshops to co-design solutions.

Our final product will be a Quality Improvement package that can be used by practices anywhere to improve repeat prescribing.

Predicted outcomes include a safer service for patients by reducing the chance to harm, reduce the burden on primary care staff, more opportunities to review patients and releasing GP capacity away from unnecessary administrable tasks.

How you can contribute

We would like to hear examples of good practice to understand the methods that achieved those results. We would also like to hear form those with experience of quality improvement and process mapping in primary care. We would welcome involvement from Q members who have a role or interest in repeat prescribing.

Reviewer feedback

This is a great project because…

This project focuses on an area with wide applicability and offers the potential to improve processes, workflow and save money. The collaborative approach will facilitate sharing learning across Wales.

By the time of the event we encourage the project team to think more about…

The project team have been thoughtful about how they will share learning within the collaborative but we would like to see how they will share beyond the project and with the Q community more widely.

Supporters

Amount requested

£30k

Idea themes

Quality improvement

Primary care

Person-centred care

Patient safety

Patient and public involvement

Community and voluntary

Access

Idea locations

Wales

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Comments

This is a great idea. When I deliver QI training in different settings, this issue comes up repeatedly and the amount of rework is huge. May be worth including some of the medical system software providers in the work as it is often limitations of the software that holds back our improvements.

Thank Joanna.
One of the things that has been suggested is we fund some interested people in situ to write templates. I've had this explained to me and what might help if rather than looking at whole system changes we train those in practice to modify the software themselves. That way the changes are owned and fit to local circumstances.
Thanks for your interest - don't forget to become a supporter!

I am a GP in England and would agree with your observations. This wasted time means less valued time with patients who need me expertise, but also with my own family. I would be interested in any shared learning across the countries of the UK. In England, with the shortage of GPs, many practices are starting to employ pharmacists to look at their systems and processes. Anecdotal feedback is this has been great for patient care in terms of safety, but also saving GP time. I welcome your ideas and working with our pharmacist has been a real addition to our practice team. Good luck!

Hi Paul, repeat prescribing has been acknowledged for years as an inefficient and unsafe system so any attempt to help improve the system has to be worthwhile. Where does ePS and eRD sit in your plan? An integral part of it to help with future spread?

Hi Michael,
Interesting question. We don't actually have ePS and eRD in Wales so it won't be part of what we are doing - BUT - what we are doing will be more about helping people within a practice understand their systems so they can improve and redesign them rather than impose a one size fits all solution. My experience and understanding is that externally imposed electronic solutions rarely work if there isn't local ownership. What we learn will be applicable all over the UK hopefully and will be usable in the context of whatever tools are available to that practice.

If you’re interested in NHS Communities of Practice (CoPs), please join Q’s CoPs special interest group’s Zoom call on 13 July (1pm) to hear about the evaluation of the Health Innovation Network’s CoPs – their challenges and their journey.
** More info/to register: https://q.health.org.uk/event/the-sustainability-and-impact-of-nhs-communities-of-practice-lessons-from-a-rand-europe-evaluation/**
The call will be an opportunity to glean advice and insights to help this project too.

We have been working on a way to pass information relating to patients' signs and symptoms to pharmacists and prescribers, so that those reviewing medication have a full picture of ongoing problems at a glance. We'd be very happy to contribute to this important initiative. More information:
http://www.swansea.ac.uk/adre/

Hi Paul,
At Wessex AHSN we have been doing a lot of work on electronic repeat Dispensing (eRD) as a means of reducng the Repeat Presribing burden. We have developed an implementation handbook, and also have some videos in production. Happy to have a chat about our work and learning - theres too much to write here! Vicki

Thanks Vicki.
We don't have eRD in Wales but it would be great to hear about your experience and ideas. What we hope is that our work will be more about helping people understand their own systems and the demand it places on workload so they can better redesign workflow.
If you are at Q conference please come and say hello!